Addressing Structural Racism, Bias, and Health Communication as Foundational Drivers of Obesity Proceedings of a Workshop Series (2022) / Chapter Skim
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11 Systems Applications to Address Structural Barriers to Obesity Solutions
11 Systems Applications to Address Structural Barriers to Obesity Solutions
Pages 89-98
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From page 89... ...
and root causes (e.g., exclusion ary zoning) that perpetuate poverty and poor health builds the capacity of community assets and resilience, and is a more efficient way to address health inequities relative to focusing on individual or environmental determinants of health.
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From page 90... ...
As Saha and her colleagues recognized that the community's food and activity environments did not support healthy eating and regular physical activity, they began to construct geographic information systems maps of their patients' environmental contexts. As a new method of analyzing patient data, Saha explained, this exercise revealed that areas of concentrated poverty also had higher rates of poor health outcomes, such as childhood obesity.
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From page 91... ...
. Although the structural solution had led to changes in the resources available to those women who had moved, Saha observed, moving also had reduced their levels of allostatic stress, which had led directly to the substantial differences observed in the development of chronic disease.
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From page 92... ...
In Rhode Island, she reported, clinical community teams are stratifying people with diabetes in terms of COVID-19 risk, physical health risk, mental health risk, and social risk to determine how best to address those domains of well-being holistically. This effort involves connecting with community-based organizations and public health departments to coinvest in improving access to resources and advancing policies with the potential to mitigate root causes of poverty.
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From page 93... ...
The Methodist Health Care Ministries went even further to help interrupt the cycle of intergenerational poverty, she added, by expanding Medicaid and investing in internet access, computers, and digital literacy for communities in greatest need. To end her remarks, Saha asserted that this kind of broader thinking that addresses root causes is a more efficient way to address health inequities compared with focusing solely on individual or even environmental determinants of health.
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From page 94... ...
Godsil went on to discuss civil rights solutions, explaining that weight is not a protected class under federal civil rights statutes even though weight stigma is a powerful form of bias. By contrast, she elaborated, exhibiting bias toward other identity categories is viewed as inconsistent with egalitarian values.
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From page 95... ...
Godsil explained further that when discussions of a particular problem emphasize existing disparities, support for structural solutions to that problem is lower. Health information that emphasizes racial health disparities may activate stereotype threat, she elaborated, undermining the affected group's sense of possibility and increasing allostatic load and other adverse psychological responses.
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From page 96... ...
Saha cited such initiatives as Purpose Built communities that integrate mixed-income housing with a stabilization lens, which she explained are less about moving people and more about investing in changing the conditions of a place so people can retain their community supports while having other conditions vital to thriving. Changing Narratives to Foster Systems Change Silvera recounted Godsil's suggestion to approach obesity solutions through a lens of hope and build on existing strengths, and asked her whether the changes that need to occur at the individual level can also be considered systems change if they effect systems outcomes.
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From page 97... ...
Effects of Framing Communications around Disparities A participant asked Godsil whether leading with disparities activates stereotype threat when communications are targeted to children. Research suggests that such communications can activate stereotype threat, Godsil replied, if the children are seen as a stigmatized group, whereas when communications about an issue are targeted to groups that are not stigmatized, leading with disparities can evoke a sense of moral urgency.
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